Significance of Hepatic Vein Reconstruction in Hepatectomy for Hepatic Metastases of Colorectal Cancer.

Use of ultrasonographic demonstration of hepatic venous flow to aid decisions on venous reconstruction during hepatectomy in a patient with an inferior right hepatic vein.

“…8,9 Partial hepatectomy with combined resection of the RHV and MHV allows the surgeon to preserve segments 5 and 6, but it usually requires reconstruction of the veins to avoid con- gestion in those segments. 1,5 The case described here presented us with that dilemma.…”

“…Because such congestion occasionally induces hepatic failure (particularly in patients with impaired liver function), reconstruction of the major hepatic veins is required. 1 It has been shown that hepatectomy with resection of the RHV and without venous reconstruction is possible if the patient has an inferior right hepatic vein (IRHV). [2][3][4][5] In this report, we describe a patient with an IRHV who underwent hepatectomy of segments 7 and 8 and part of segment 4, along with resection of the RHV and MHV, without reconstruction.…”

Reconstruction of hepatic or portal veins by use of newly customized great saphenous vein grafts

“…This vein itself is too thin for one to use to reconstruct the thick major hepatic veins or portal veins, and size-mismatch at the anastomosis will cause the occlusion of the vein graft [2]. Urayama et al reported remodeling a vein graft to reconstruct the jugular and portal veins, making twice the diameter and half the length of the original GSV [3].…”

“…Curative resection of such cancers can be achieved by complete removal of the infiltrated vein and subsequent reconstruction with an interpositioning or patch graft. The great saphenous vein (GSV) [1,2,3,4], external iliac [1,2,5] or superficial femoral vein [2], gonadal vein [6] and left renal vein [7] have been used as vein grafts; of these, the external iliac, superficial femoral and left renal vein graft can ensure enough diameter and length for reconstruction of such intrinsic veins. However, the sacrificing of the iliac vein or left renal vein is sometimes associated with postoperative edema of the lower leg or impairment of renal function in poor-risk patients [8].…”

Reconstruction of the portal and hepatic veins using venous grafts customized from the bilateral gonadal veins

“…However, when a direct suturing or direct anastomosis has some risks of kinking, stenosis, or overtension, a venous graft will be necessary. Some authors have reported the usefulness of autologous venous grafts created from the internal jugular vein [1,2], left renal vein (LRV) [3][4][5][6][7][8][9], external iliac vein [10][11][12][13][14], and superficial femoral vein [11]. Others have utilized customized venous grafts made from lesser veins, such as the great saphenous vein [10,11,[15][16][17] or right ovarian vein [18], to avoid deficiency or complications associated with sacrificing intrinsic thicker veins.…”